A diagnosis of cancer can be world shattering for patients on many levels, especially in terms of their ability to pay for a potentially lifesaving treatment regimen. A study by the National Cancer Institute (NCI) found that many drugs and biologics commonly used to treat cancer now exceed $10,000 per month.1

As the cost of treating the disease has risen, so too have the direct medical care expenses that patients pay out of pocket, as commercial insurers increasingly shift the burden of paying for treatment to patients through higher premiums, deductibles, and co-pays. A 2016 survey found that 33% of insured adults aged 19 to 64 years had problems paying their medical bills or were in debt as a result.2

The financial toxicity caused by a cancer diagnosis has been found to have a negative effect on patient adherence to their treatment regimen. One study found that among women with breast cancer who were eligible for Medicare, a 90-day co-pay of $30 to $89.99 (adjusted odds ratio [OR], 0.83; 95% CI, 0.72-0.96) or above $90 (adjusted OR, 0.70; 95% CI, 0.60-0.82) was associated with reduced adherence compared with a co-pay below $30.3

Because of the tremendous burden of treating cancer, both physically and financially, the NCI recommends that treatment centers offer finan- cial counseling to help patients and their families, including estimates of their out-of-pocket costs. At Hematology-Oncology Associates of Central New York (HOACNY), financial counseling services are a vital component of each patient’s therapy. This includes hunting down support from manufacturers and foundations to help patients with their out-of-pocket expenses. HOACNY staff noted that many patients may be unaware of the services available from these resources.

“We fight every day for our patients here, and we’re constantly monitoring the open foun- dations for patients,” said Deborah Walters, RN, OCN, dispensing nurse navigator at HOACNY. “This can be very time consuming, but it’s all for our patients. We’ll do whatever it takes to ensure them that they can receive their medications for their diagnosis.”

HOACNY is a large multispecialty community oncology practice with 4 locations staffed by 17 physicians and 260 employees. Their services include clinical drug management by oncology pharmacists, infusion chemotherapy, oral chemotherapy, supportive medications, and physician dispensing and clinical research support.

At the time of patient referral following a diagnosis, HOACNY staff perform a benefit investigation to see whether the patient’s insurance is active and participating. At that time, they identify what the overall cost could be to the patient, their possible payment responsibility, and which types of assistance they may qualify for to access their treatments and move forward with care.

“We’re trying to see, based on the patient’s diagnosis, what type of either foundation or drug assistance they may qualify for. We’re also looking to see if we can find other insurance that may better cover that patient,” said Jennifer St. Andrew, patient financial services manager at HOACNY. “We can also offer some type of monthly budget. So for some patients, instead of having to pay a co-pay every time they come in, where that can be a little anxious to them, we might set them up on a monthly budget where they’re making a monthly payment to us. I think the greatest help is the foundation drug assistance that we’re able to find for the patient, some of which will reimburse them for their insurance premium.”

Within the practice is also a social work team that meets with the patient to discuss and address any types of stressors that they may be facing, including financial. In addition to benefits investigation, the staff tries to find the lowest-cost drugs available.

“If the medication is available at a generic cost that is substantially cheaper, the out-of-pocket costs are lower,” said Bethany Joss, CPhT, at HOACNY. “Sometimes if it’s an oral medication, the treatment can be dispensed through their medical plan, and it would take that co-pay away.”

Services also include partnerships with independent insurance agents who assist patients with Medicare coverage and any type of supplemental insurance available that helps them access all possible resources within the community, ensuring they have support to help with the cost of treatment.

“We have a very good understanding of the assistance that may be out in the community,” St. Andrew said. “We’re looking at the foundations and the [manufacturer] drug assistance; we’re looking at the insurance. But if there’s a time where we’re starting to see some of these grants have exhausted their funding or we’re trying to look for a diagnosis that we don’t see as often, we do have a program here called Assist Point. What’s really nice about this system is that it will monitor any foundation or drug assistance within the country and it lets us know, based on the patient’s diagnosis, what might be available for assistance.”

In the case of an oral chemotherapy prescription, for example, staff members investigate what a patient’s co-pay is and if it’s extremely high. The staff will search for co-pay assistance to bring their balance down to a minimal or zero balance. If there are no foundations available for assistance, patients are referred to pharmaceutical companies for free medications.

“The patients get diagnosed, they come in, and they meet with the oncologist. They now are really getting a confirmation of that diagnosis, but they’re also understanding what their future is going to look like, what treatments they’re going to need, and how they’re going to fight this,” St. Andrew said. “A lot of times, what we hear from our patients is that they understand, or sometimes there’s a lack of understanding, on exactly what their insurance is going to cover and what exactly their patient responsibility is going to be. Just having a team of people here within our practice who can sit down with each one of these patients, do an analysis, really break down what their responsibility is going to be, and then on top of that, pairing it with assistance that will help them with the patient responsibility, it always provides an ease to them.”

HOACNY staff emphasized the importance of establishing a coordinated care network, including financial counseling, that can support the patient from their diagnosis throughout their treatment to maintain optimal adherence and achieve the best possible outcomes.

“A lot of patients will come back and say, ‘I was so concerned about this, but now I know I’m going to be okay. I’ve got some assistance that’s going to help me pay for this,’” St. Andrew said. “They’re very appreciative that there’s a whole dedicated team here that is advocating and walking through their journey with them.”
 
Davy James, Managing Editor

References

1. Financial toxicity and cancer treatment (PDQ)-health professional version. NCI website. cancer.gov/about-cancer/managing-care/track-care-costs/ nancial-toxicity-hp-pdq. Accessed July 10, 2019.
2. 2016 Biennial Health Insurance Survey. The Commonwealth Fund website. commonwealth- fund.org/publications/surveys/2017/feb/2016-biennial-health-insurance-survey. Published February 1, 2017. Accessed July 10, 2019.
3. Neugut AI, Subar M, Wilde ET, et al. Association between prescription co-payment amount and compliance with adjuvant hormonal therapy in women with early-stage breast cancer. J Clin Oncol. 2011;29(18);2534-2542. doi: 10.1200/JCO.2010.33.3179.